Clinical accuracy of preoperative breast MRI for breast cancer

Tseng, Jennifer F.; Kyrillos, Alexandra; Liederbach, Erik; Spear, Georgia Giakoumis; Ecanow, Jacob S.; Wang, Chi‐Hsiung; Czechura, Tomasz; Kantor, Olga; Miller, Megan E.; Winchester, David J.; Pesce, Catherine; Rabbitt, Sarah; Yao, Katharine

doi:10.1002/jso.24616

Cited by 19 publications

(17 citation statements)

References 43 publications

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“…Magnetic resonance imaging (MRI) has been shown to be the most accurate diagnostic tool for breast cancer diagnosis and follow-up care [6] and provides greater accuracy for tumor size prediction than mammography and ultrasound in patients not receiving neoadjuvant therapy [7]. Several studies have investigated the diagnostic power of breast MRI during and/or after NACT [8–13].…”

Section: Introductionmentioning

confidence: 99%

Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

et al. 2019

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BackgroundPatients with early breast cancer (EBC) achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) have a favorable prognosis. Breast surgery might be avoided in patients in whom the presence of residual tumor can be ruled out with high confidence. Here, we investigated the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) in predicting pCR and long-term outcome after NACT.MethodsPatients with EBC, including patients with locally advanced disease, who had undergone CE-MRI after NACT, were retrospectively analyzed (n = 246). Three radiologists, blinded to clinicopathologic data, reevaluated all MRI scans regarding to the absence (radiologic complete remission; rCR) or presence (no-rCR) of residual contrast enhancement. Clinical and pathologic responses were compared categorically using Cohen’s kappa statistic. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS) and overall survival (OS).ResultsOverall rCR and pCR (no invasive tumor in the breast and axilla (ypT0/is N0)) rates were 45% (111/246) and 29% (71/246), respectively. Only 48% (53/111; 95% CI 38–57%) of rCR corresponded to a pCR (= positive predictive value - PPV). Conversely, in 87% (117/135; 95% CI 79–92%) of patients, residual tumor observed on MRI was pathologically confirmed (= negative predictive value - NPV). Sensitivity to detect a pCR was 75% (53/71; 95% CI 63–84%), while specificity to detect residual tumor and accuracy were 67% (117/175; 95% CI 59–74%) and 69% (170/246; 95% CI 63–75%), respectively. The PPV was significantly lower in hormone-receptor (HR)-positive compared to HR-negative tumors (17/52 = 33% vs. 36/59 = 61%; P = 0.004). The concordance between rCR and pCR was low (Cohen’s kappa − 0.1), however in multivariate analysis both assessments were significantly associated with RFS (rCR P = 0.037; pCR P = 0.033) and OS (rCR P = 0.033; pCR P = 0.043).ConclusionPreoperative CE-MRI did not accurately predict pCR after NACT for EBC, especially not in HR-positive tumors. However, rCR was strongly associated with favorable RFS and OS.Electronic supplementary materialThe online version of this article (10.1186/s13058-018-1091-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

et al. 2019

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“…Therefore, the early detection and accurate preoperative staging and treatment of breast cancer are crucial to improve the prognosis (11,12). Many studies have been reported on the value of US combined with MRI detection in breast cancer staging, but most of them only focus on T staging and diagnosis efficiency, few only on N and M staging (13). Therefore, in this study, the diagnostic value of US combined with MRI in the T, N and M staging of breast cancer was analyzed, in order to provide a more effective, sensitive and accurate detection program for the early diagnosis and accurate staging, improving the efficacy of patients' subsequent treatment and the prognoses.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of ultrasound combined with magnetic resonance imaging in different stages of breast cancer

Pan¹,

2018

Oncol Lett

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Diagnostic value of ultrasound (US) and magnetic resonance imaging (MRI) in breast cancer were investigated. One hundred and forty breast cancer patients diagnosed in Heping Hospital Affiliated to Changzhi Medical College from June 2016 to June 2018 were collected, used as breast cancer group, 80 patients with benign breast tumor in the same period were the benign group. Pathological results were used to compare the diagnostic coincidence of US and MRI in breast cancer patients. The positive expression case rates of estrogen receptor and progesterone receptor were significantly higher in breast cancer group than those in benign group, but that of human epidermal growth factor receptor 2 (Her-2) was significantly lower in breast cancer group than that in benign group (all P<0.05). The sensitivity (SEN) of MRI alone and that of US combined with MRI were higher than that of US alone (P<0.05). The specificity (SPE) of MRI alone was lower than that of US alone and US combined with MRI (P<0.05). The NPV of US combined with MRI was significantly higher than that of US alone (P<0.05). The Youden index (YI) of US combined with MRI was significantly higher than that of US alone and MRI alone. In the diagnosis of N2, that of US combined with MRI was significantly higher than those of US alone and MRI alone (P<0.05). In stages of M0 and M1 among three methods, those of MRI alone and US combined with MRI were higher than that of US alone (P<0.05). US combined with MRI for the diagnosis of breast cancer has higher SEN and SPE, with better accuracy rate for the identification of each stage. Reducing the incidence of missed diagnosis and misdiagnosis that may be caused by single diagnosis and treatment, it is conducive to clinical screening and guiding clinical symptomatic treatment.

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“…Establishing the management on radiologic tumor size and thus clinical stage in these cases can result either in a procedure that would otherwise not be necessary or on the other hand conservative and thus inadequate treatment. A recent study by Tseng et al 10 assessed the accuracy of MRI alone versus a combination of USG plus MG in accurate estimation of tumor size. Interestingly, instead of using an absolute value of 2 mm or 5 mm, they used a size difference of less than 33% as concordant.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9] Some authors looked into tumor size concordance with respect to different imaging modalities, but many of these studies were limited, either by small sample size; because only a specific type of tumor was considered based on the exclusion criteria; or because only highly specialized techniques such as magnetic resonance imaging (MRI) was used, which is not as widely available or used as ultrasonography (USG) in the assessment of the breast carcinomas. [10][11][12][13][14][15][16][17][18][19][20][21] Moreover, most studies considered a size difference of AE5 mm to be concordant, 11,13 which is significant enough to result in a change of stage classification in a considerable number of cases. We compared pathologic tumor size with ultra-sonographic (USG) size.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma

et al. 2018

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Background: Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/ clinical staging is. Materials and methods: The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within AE2 mm. Results: The difference between radiologic and pathologic tumor size was within AE2 mm in 40.4% cases. The mean radiologic size was 1.73 AE 1.06 cm. The mean pathologic size was 1.84 AE 1.24 cm. A paired t-test showed a significant mean difference between radiologic and pathologic measurements (0.12 AE 1.03 cm, p ¼ 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors 2 cm (pT1) (51.1%) as compared to those greater than 2 cm (!pT2) (19.7%) (p < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) (p < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors (p ¼ 0.02). Conclusion: Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate.

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Clinical accuracy of preoperative breast MRI for breast cancer

Abstract: Breast MRI provides greater accuracy for a third of patients undergoing preoperative MGM and U/S. Mammographic calcifications were associated with MRI clinical accuracy for patients with invasive cancer.

Cited by 19 publications

References 43 publications

Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR)

Diagnostic value of ultrasound combined with magnetic resonance imaging in different stages of breast cancer

Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma

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